CHANGES OVER TIME IN THE PARS FLACCID OF THE TYMPANIC MEMBRANE IN CASES OF INTRACTABLE OTITIS MEDIA

• Published in: JIBI INKOKA TEMBO Vol. 48; no. 4; pp. 221 - 229
• Main Author: Kamide Yosuke
• Format: Journal Article
• Language: Japanese
• Published: Society of Oto-rhino-laryngology Tokyo 2005; 耳鼻咽喉科展望会
• Subjects: acute otitis media; cholesteatoma; otitis media with effusion; pars flaccid; 小児中耳炎; 弛緩部型中耳真珠腫; 画像ファイリング; 鼓膜弛緩部
• ISSN: 0386-9687; 1883-6429
• DOI: 10.11453/orltokyo1958.48.221

We observed the clinical course of pediatric patients with intractable otitis media who were examined at our otorhinolaryngological clinic, focusing on changes in the pars flaccid of the tympanic membrane.An endoscope for the tympanic membrane, a CCD camera, and an image-filing computer were exclusively used for the detailed observations.The criteria for the selection of patients in this study were as follows : 1) Patients who had received treatment for recurrent or intractable (acute, exudative) otitis media for at least one year from the time of the initial examination.2) Patients meeting the above-mentioned criterium and for whom images for at least 3 years had been stored.3) Young patients aged 20 years or under.Based on these selection criteria, 240 pediatric patients with otitis media were selected from among those who were brought to our clinic between 1996 and 2003 ; these study subjects were retrospectively evaluated using the images stored in the computer.Retraction of the pars flaccid of the tympanic membrane was classified according to Tos' method.1. According to Tos' method for classifying the severity of retraction, 452 ears were classified into types 0through IV. On initial examination, type 0, I, II, III, and IV retraction was recognized in 43.4%, 36.0%, 16.4%, 4.0%, and 0.2% of the total ears, respectively. On final examination, type 0, I, II, III, and IV retraction was recognized in 40.9%, 39.0%, 14.8%, 4.6%, and 0.2% of the total ears, respectively. The patient whose ear exhibited a type N retraction at the initial examination (0.2%) continued to exhibit a type N retraction at the final examination.2. With regard to improvement in the retraction of the pars flaccid of the tympanic membrane, types 0 through II showed a higher likelihood of being restored to a normal position, with improvement of the mesotympanum, than type III, in which there appeared to be little possibility of improvement.3. Many children with Down syndrome or cleft palate were included among the patients with type III retraction. This result suggests that tubal insufficiency may underlie the progression to type 111 retraction.4. None of the patients in the present study exhibited the formation of cholesteatoma on the pars flaccidof the tympanic membrane. 耳鼻咽喉科診療所を受診する小児中耳炎のうち反復性, 遷延性, 難治性滲出性中耳炎罹患児を中心に鼓膜弛緩部の変貌について検討した。観察には鼓膜内視鏡とCCDカメラならびに専用の画像ファイリングコンピュータを用いた。対象症例は240名で, 1年におよぶ治療を継続し, 少なくとも3年以上経時的に追跡している症例とした。弛緩部陥凹評価はTosの分類を用いた。結果1.Tosの病型分類に基づいて0-IV型に分類した結果, 初診時0型は43.4%, I型は36.0%, II型は16.4%, III型は4.0%, IV型は0真2%であった。終診では, 0型は40.9%, I型は39.0%, II型は148%, III型46%であった。IV型は初診時1例 (0.2%) に見られ, 終診でもこの症例のみに見られた。2.弛緩部陥凹の改善についてはII型までであれば中鼓室の改善に伴って正常位置に回復する場合もあるが, III型になると改善が見込めないことが多い。3.III型でダウン症候群や口蓋裂の子供たちが多く含まれることから, III型にいたる症例の背景には潜在的に耳管機能不全があるものと推測される。4.今回の調査では弛緩部型真珠腫を形成する症例は見られなかった。